HomeMy WebLinkAbout1219 lA~t• 3ast~aaf pr~pas~d ~t ~i~q l+dl~r, P.O.Dos 861it, ~rad~ato~n. ?l~.
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Propeity to be improved: .....~iaR..l.-.yio~ill--Yi11aQ~e--.~"1b~..-S~a,. ..............._._.._.._w...._......
..aooo~d:ir!9..t~o Plat th~c~o~.c... pl~..?t..eook_15,~.
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ication) ..8t. Looi~ Goynty, ~larida.
General description of the improvement: ~
FILEO A~1b~~~~0~~~~~.
lycrutioo~l taailit~ ST. LU G 1 E C 0 U NT Y.
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'70 P1~Y 6 PN • 8
Name and address of Ownes: ...y,~a~i1L.Y.iLlaq~p*H~~~~,..Iaa.•-------------~j-~ . ~
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Extent of Oumer's interest in prope~ty: (fee simple) other:
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Name and add~ess o ee sim te title holde~ i other than Owner. ~u
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f owne~ship u other than fee simple, the name and add~eu of the fee simple title holder must
aIso be ~iven)
Name and address of Contractor: ~1~7.
~s~!~O°
P. O. Hoot 938, l~o~t Pi~roa, tl+oaclda
Nat3ie and acldseu of su~ety on pa~~ment bond, if any, and amount of the bond:
- 11oR~
Amount
~ Name and add~ess, within the State of Florida, of a pe~son othes than the Owner signing this
notice, designated by the undersigned to receive service of notices o~ other documents:
D~ Y~aq~r. Aostt~s 1, J~a~ e~at,~. tlos'ida.
Name and add~ess of ~e~son to receive co¢y of Lienors Notice as provided in Sec. 84.061(2)(b)
Florida Statutes (Optional).
pated thu-------¢------~aY of.___....~s 19__.2Q~?
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N-~•.., ~Eg~[a'ture of wne~ ( authorized agent)
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~./:.E M`O (4 ,~a~cd sworn to befo~e me this..-..- o _
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'~,,~~0,~ . Add acknomled~~ ~o Ou~ne~ or autho~ized a ent o Ownes
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